Please use the following form to enroll for Rail-Road Medicare:
{{ :edi_rr_enroll_app_1_.pdf |**Rail-Road Medicare EDI Enrollment Application**}}

**Submission Instructions:**  
Once you have completed the form, please submit it via **fax** or **email** using the details below:

  * **Fax:** 803-382-2416 (*Be sure to include area code 803 when dialing the fax number.*)  
  * **Email:** [RREDI.ENROLL@PalmettoGBA.com](mailto:RREDI.ENROLL@PalmettoGBA.com)

After submission, please notify us so we can enable the payer for you.

If you have any questions, feel free to reach out. We’re happy to assist!